Healthcare Provider Details

I. General information

NPI: 1407866502
Provider Name (Legal Business Name): CLINICAS DE SALUD DEL PUEBLO, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 02/18/2022
Certification Date: 02/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 MAIN ST
BRAWLEY CA
92227
US

IV. Provider business mailing address

900 MAIN ST
BRAWLEY CA
92227
US

V. Phone/Fax

Practice location:
  • Phone: 760-344-6471
  • Fax: 760-344-8509
Mailing address:
  • Phone: 760-344-6471
  • Fax: 760-344-8509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY44279
License Number StateCA

VIII. Authorized Official

Name: MR. ROGER G IRVING
Title or Position: PHARMACY DIRECTOR
Credential: RPH
Phone: 760-344-6471